Postpartum

Congratulations!The joys and challenges of motherhood have begun. Remember to take care of yourself, too. Caring for a new baby can be fun, but it is also hard work. You have experienced nine months of changes in your body. Those changes will continue in the next couple of months, as your body recovers from having the baby. It is important to make and keep your postpartum follow-up appointment. Every baby deserves a healthy mom!

Maternity care

Taking care of both of youHave you added your baby to your policy yet? For your health plan to cover any of your baby’s claims — hospital, physician or others — you must enroll your baby and pay your premiums. Be sure to enroll your baby in your health policy if you haven’t already done so.

If you didn’t receive the Tdap vaccination before delivery, you might have received it in the hospital. This will help protect both you and your baby from the very contagious bacteria that causes pertussis, also known as whooping cough. This disease can make your baby very ill. The current recommendations are for everyone age 11-64 to have a booster shot. Babies don’t start this immunization series until around 2 months and might not be fully immune until after the third dose. Ask your health care provider at your postpartum visit about this important protection.

Regaining a healthy weight and shape

If you want to diet and are breast-feeding, it is best to wait until your baby is at least 2 months old. During that time, your body needs to recover from childbirth and establish a good milk supply. Then, when you start to lose weight, try not to lose too much too quickly. This can be harmful to the baby because environmental toxins that are stored in your body fat can be released into your breast milk. Losing about one pound per week (no more than four pounds per month) is a safe amount and will not affect your milk supply or the baby’s growth.

You can safely lose weight by consuming at least 1,800 calories per day with a well-balanced, nutritious diet that is rich in calcium, zinc, magnesium, vitamin B6 and folate. Diets in which you consume fewer than 1,500 calories per

day are not recommended at any point during breast-feeding. This can put you at risk for a nutritional deficiency, lower your energy level and lower your resistance to illness.

Now that you’ve delivered your little bundle of joy, you may be eager to get back to your pre-pregnancy weight. If so, make sure you do it in a healthy way. Consult your doctor before you start any type of diet or exercise plan.

Here are some of the things you can expect:

• You will have spotting or bleeding, like a menstrual period, off and on for up to six weeks.

• You might also have swelling in your legs and feet. You can reduce swelling by keeping your feet elevated when possible.

• You might feel constipated. Try to drink plenty of water and eat fresh fruits and vegetables.

• Menstrual-like cramping is common, especially if you are breast-feeding. Your breast milk will come in within three to six days after your delivery. Even if you are not breast-feeding, you can have milk leaking from your nipples, and your breasts might feel full, tender or uncomfortable.

After the birth of your baby, your doctor will talk with you about things you will experience as your body starts to recover.

Physical changes

Follow your doctor’s instructions on how much activity, like climbing stairs or walking, you can do for the next few weeks. Doctors usually recommend that you abstain from sexual intercourse for four to six weeks after birth. Before resuming sexual intercourse, talk with your doctor about your plan for birth control, since you can become pregnant again. Breast-feeding alone does not protect you from getting pregnant.

According to the recommendations of the American Congress of Obstetrics and Gynecology, you should seek help if you notice any of these symptoms:

• The baby blues do not start to fade after about a week, or the feelings get worse.

• Strong feelings of depression and anger come one to two months after childbirth.

• Feelings of sadness, doubt, guilt or helplessness seem to increase each week and get in the way of normal functions.

• You are not able to care for yourself or your baby.

• You have trouble doing tasks at home or on the job.

• Your appetite changes.

• Things that used to bring you pleasure no longer do.

• Your concern and worry about the baby are too intense — or on the other extreme, you lack interest in the baby.

• You have anxiety or panic attacks. You may be afraid to be left alone in the house with the baby.

• You fear harming the baby. These feelings can be scary, even though most women with postpartum depression never act on them. These kinds of feelings may lead to guilt, which makes the depression worse.

Getting rest The first few days at home after having your baby are a time for rest and recuperation, physically and emotionally. It takes a lot of energy to care for a newborn. Even though you may be very excited and have requests for lots of visits from family and friends, try to get as much rest as possible. Don’t expect to keep your house perfect. You may find that all you can do is eat, sleep and care for your baby. And that is perfectly OK. Learn to pace yourself from the first day that you arrive back home. Try to lie down or nap while the baby naps. Don’t try to do too much around the house. Allow others to help you and don’t be afraid to ask for help with cleaning, laundry, meals or caring for the baby.

Singing the blues?You may have heard the term “baby blues.” Be aware that there is a difference between “normal” blues due to hormonal changes after delivery and more serious postpartum depression. Seventy to 80 percent of new mothers experience anxiety, crying or even anger two to three days after birth. These feelings should go away within a week or so.

Postpartum depression can happen anytime during the first year after delivery, but generally begins one to three weeks after delivery. The U.S. Preventive Services Task Force recommends screening for depression in the general adult population, including pregnant and postpartum women. Your health care provider may ask you to complete a screening for postpartum depression. This allows for early diagnosis and treatment to help you get the care you need and get back to enjoying your new family.

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Breast-feeding and work?You may wonder if you can continue to breast-feed after returning to work. The answer is yes!

Postpartum checklist

The most important thing to remember is that communication is key! Work with your boss to figure out a plan that works for everyone without interrupting your responsibilities at work.

Here are some tips to help make the transition easier:

• If possible, return to work gradually. Perhaps you can work with your boss to create a schedule where you start your return by working 20 hours per week, gradually increasing the amount of time you spend at work and away from your baby. This gives you more time to adjust and helps your body make a good supply of milk.

• Get a quality breast pump. A good, electric breast pump may be your best bet for efficiently expressing milk during the workday.

• Find a private place to express milk. Work with your supervisor to find a private space.

• Follow a schedule to express milk. Express milk for 20 minutes two or three times during a typical eight-hour workday. A sample schedule might look like this: 8 a.m. Begin work 9–9:20 a.m. Use break to express milk Noon Take allowed lunch break to express milk 2–2:20 p.m. Use break to express milk 5 p.m. Leave work

• Storing your milk: Because your milk is full of antibodies that fight germs and bacteria, it can be safely stored and given to your baby later. Breast milk is food, so it is safe to keep in an employee refrigerator or a cooler with ice packs. Discuss with your supervisor the best place for you to store your milk.

Appointments to make sure you and your baby are healthy don’t automatically end at delivery. Make sure you:

• Schedule and keep your postpartum doctor’s appointment. This appointment is sometimes referred to as a “six-week checkup.” This visit allows your doctor to check on your recovery from childbirth, both physically and emotionally. Even if you are seen for an issue or re-check within the first one to two weeks after delivery, you still need to be seen again between four and six weeks after your delivery for your complete postpartum evaluation.

• Schedule and keep your baby’s first well-baby visits. These visits will allow your baby’s pediatrician to monitor his or her health, growth and development. Your baby will also receive a series of recommended vaccinations.

If you have questions along the way, be sure to write them down. Your postpartum appointment and your baby’s pediatrician visit are great opportunities to address any issues or concerns you have about your and your baby’s health.